Unnecessary risks?
Playing any kind of ER roulette -- whether it's because the closest one is closed or you're worried about the quality of care -- makes many doctors squirm. In Spry's case, her doctor now advises her to skip her local hospital and drive another 15 or 20 minutes to another that seems more prepared to treat kids. "It's a tough situation to advise people to bypass the nearest medical center because the vast majority of real emergencies involve breathing problems," says Joan Naidorf, D.O., an ER physician at Inova Alexandria Hospital in Alexandria, VA.
Take choking, for example. Many parents are tempted to jump in the car and race to the hospital, says Dr. Fitzmaurice. "But if you get halfway to the ER and he stops breathing, you're behind the eight ball. You're on a highway trying to call 911 from a cell phone." And if you'd decided to shoot for the bigger -- but farther away -- medical center, the stakes could be even higher. Because of that, Dr. Naidorf believes the need for immediate treatment should trump fears that some staff may be less experienced in dealing with children.
Dr. Fitzmaurice completely agrees -- in a critical situation, call 911 or head to the nearest hospital (see page 88 to learn how to make the safest decision). That said, she also sees nothing wrong with taking more time to get to a hospital that specializes in pediatrics in less urgent situations. If your child has hit his head and you suspect a concussion, any ER doc can diagnose it, but doctors at a children's hospital will be more able to give you advice on after- effects and continuing care specific to children and adolescents.
Meg Falciani performs just this kind of triage when any of her four children is ill or injured. "If it's life-or-death, it's the closest place," says Falciani. "The problem is that whole very gray area in the middle that children love to be in."
And like Falciani, most parents will at some point be forced to navigate that gray area and make a scary call. But no parent should have to worry that the hospital she takes her child to may not be adequately equipped, prepared, or fully trained to care for him. Yet millions face that reality every day. In fact, when the American College of Emergency Physicians issued its latest report card in December on the state of emergency care in the U.S., it gave the country a D- on access to care and only a C+ for quality and patient safety environment. The work to be done is staggering, but there are some glimmers of hope.
The Wakefield Act, which is expected to be reintroduced in Congress this spring, is one of them. Its goal is to provide the necessary funds to ensure kids get the help they deserve at every hospital ER (see "Hey, Congress!" below, for more details). You are another. When moms speak out, people in power tend to listen. It's up to us to demand that the hospitals in our hometowns have the support, training, and resources they need to safely care for kids. Until we make our voices heard, we have no choice but to hope that the near misses don't get any closer.
Melanie Howard lives in Alexandria, VA.
